H1N1 Pandemic Update Section on Emergency Medicine

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  • H1N1 Pandemic Update Section on Emergency Medicine

    1. 1. H1N1 Pandemic Update Section on Emergency Medicine Steven E. Krug, MD Head, Division of Emergency Medicine Children’s Memorial Hospital Chicago, IL AAP 2009 NCE Washington, DC
    2. 2. Spring 2009 – Lessons Learned • Disconnect between federal and local pandemic planning and management recommendations • Variable screening and treatment practices across facilities/practices within local communities • Demand for clinical services by ill and ‘worried well’ patients exceeded capacity • Availability of key medications and supplies limited service delivery and placed patients & staff at risk • Impact of the pandemic on healthcare staff further reduced service capacity at all levels of care • Impact on key safety net services threatened patient care quality and safety
    3. 3. Being Aware  Being Prepared • Local epidemiology/prevalence of H1N1 • Viral screening/testing • Anti-viral therapy Treatment and prophylaxis  At-risk populations  Dosing & medication safety concerns • Vaccination • Infection control  N95/PPE use, isolation, furloughs http://aap.org/new/swineflu.ht http://www.cdc.gov/h1n1flu
    4. 4. • Disaster Planning Resources for Pediatricians  Needle: A Disaster Preparedness Plan for Pediatricians • Information on Biological, Chemical, Nuclear & Thermo/Mechanical Agents  Psychosocial and mental health considerations • Influenza  Resources for clinicians  Practice guidance, patient resources, management recommendations  Resources for patient and families  Numerous links  CDC, HHS, NCCD, others http://www.aap.org/disasters
    5. 5. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season September 22, 2009 2:00 PM ET Updated to include complications and treatment considerations for infants and young children, clarity on underlying conditions that contribute to increased risk for influenza-related complications, and information on anti-viral medication dosing and safety concerns with oral suspensions Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel October 14, 2009, 2:00 PM ET Updated interim guidance on infection control measures to prevent transmission in healthcare facilities. Emphasizes the ‘hierarchy of controls’ (Elimination of potential exposures, Engineering controls, Administrative controls, Personal protective equipment) as a strategy to protect both staff and patients.
    6. 6. http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf October 16, 2009
    7. 7. AAP DPAC Disaster Preparedness Advisory Council • Steven Krug, MD, FAAP - Chairperson • Sarita Chung, MD, FAAP • Daniel Fagbuyi, MD, FAAP • Margaret Fisher, MD, FAAP • Scott Needle, MD, FAAP • David Schonfeld, MD, FAAP • Liaison Members:  DHS/OHA, HHS/ASPR, CDC, NICHD • Laura Aird – AAP Staff
    8. 8. Pediatrics - October 2009; 124(4):1233-43. Guidelines for Care of Children in the ED Gausche-Hill M, Krug S, and the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association • Recommendations regarding personnel, training, equipment, supplies, medications, support services, quality and process improvement, policies, protocols, and other resources necessary for optimal pediatric emergency care  Updated version of 2001 AAP/ACEP joint policy statement •The presence of MD & RN pediatric coordinators may be the most important factor associated with readiness*  This ADVOCATE could be a community or hospital based pediatrician • Offers recommendations for patient safety & disaster readiness *Gausche-Hill M, et al. Pediatrics 2007; 120(6): 1229-
    9. 9. Emergency Department - Number of Patients per Day by Fiscal Year March 1st to June 10th - FY2008 to FY2009 0 50 100 150 200 250 300 350 400 450 3/1/2009 3/11/2009 3/21/2009 3/31/2009 4/10/2009 4/20/2009 4/30/2009 5/10/2009 5/20/2009 5/30/2009 6/9/2009 6/19/2009 FY08 FY09 Linear (FY08) Linear (FY09) Spike correlates with the media announcment of H1N1. Children’s Memorial Hospital, Chicago, IL
    10. 10. Comparison 08 & 09 - April 26th to June 7th 167 188 185 171 152 168 159 163 166 182 172 162 164 159 157 147 203 190 152 172 167 173 194 213 187 188 182 170 176 175 215 152 141 158 163 158 201 169 182 172 167 171 176 229 227 254 392 369 275 230 311 292 266 251 222 213 200 217 256 247 238 208 205 221 242 282 261 271 244 243 250 268 262 257 258 258 201 168 228 228 175 189 196 218 195 203 0 50 100 150 200 250 300 350 400 450 4/26/2009 4/28/2009 4/30/2009 5/2/2009 5/4/2009 5/6/2009 5/8/2009 5/10/2009 5/12/2009 5/14/2009 5/16/2009 5/18/2009 5/20/2009 5/22/2009 5/24/2009 5/26/2009 5/28/2009 5/30/2009 6/1/2009 6/3/2009 6/5/2009 6/7/2009 2008 2009 2009 Average (242 Patients per Day) 2008 Average (173 Patients per Day) Indicates Chicago Public School Closings Children’s Memorial Hospital ED Visits
    11. 11. New doll available at the American Girl Store: ‘Suzy Swine Flu’….

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